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Viagra Brasil. Citrato de Sildenafila.

É um medicamento fabricado pela empresa PFIZER, sua composição base é o Citrato de Sildenafila. Uso adulto e via oral e são distribuídos em forma de comprimidos na cor azul. E possuem três dosagens: 25mg, 50mg e 100mg. Originalmente é comercializado em embalagens:
25mg – 04 comprimidos 50mg – 02, 04 ou 08 comprimidos 100mg – 04 comprimidos

Em algumas regiГµes, pode ser encontrada a venda do produto de forma fracionada, contendo apenas uma unidade, por cartela.

Utilizado para tratamento de disfunção erétil, mais conhecida como impotência sexual e é recomendado para homens com mais de 50 anos.
O acesso ao medicamento Г© fГЎcil, mesmo sem receita mГ©dica, o paciente poderГЎ adquirir o produto em farmГЎcias ou estabelecimentos credenciados que possam vender medicamentos.
Desde seu lançamento no mercado farmacêutico, houve algumas variações nos preços praticados. No Brasil, a média de preço atualmente pode ficar entre:
R$ 12 e R$ 20 por comprimido de 25mg
R$ 15 e R$ 25 por comprimido de 50mg
R$ 30 e R$ 40 por comprimido de 100mg

As principais dúvidas sobre o uso do medicamento é em relação contra-indicações, o tempo que leva para começar a fazer efeito e sua duração.

O medicamento Г© contra-indicado para pessoas que tem hipertensГЈo ou alergias aos componentes do medicamento. NГЈo sГЈo recomendados para menores de 18 anos, mulheres, pessoas com sensibilidades cardiovasculares e usuГЎrio de outros medicamentos.
O efeito inicia em aproximadamente de 2 a 3 horas, sob efeito, permanecendo entre 3 a 4 horas. Segundo as orientações do fabricante, os efeitos podem variar de acordo com o paciente e só há efeito mediante estímulo sexual.
Foi constatado que homens de vários perfis (faixa etária, posição sócio econômica, etnia, credo, orientação sexual e outros) procuram o Viagra e similares, não somente para tratamento, mas também por curiosidade e melhoria no desempenho.
Já ganhou grande repercussão em todo o mundo por sua ação eficiente e satisfação de consumidores dos mais variados perfis. São produzidos por uma empresa com credibilidade em nível mundial, os pacientes sentem-se mais seguros em usar medicamento, mesmo sem recomendação médica.
A versão genérica do Viagra tem um preço mais acessível, tem ganhado sua parcela de consumidores, aos poucos sua demanda vem aumentando e mostrando confiabilidade. Os relatos dos pacientes que usaram a versão genérica, afirmaram que produto tem o mesmo efeito da sua versão original.
O uso de qualquer medicamento pode ser perigoso para sua saГєde, procure um mГ©dico.

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Veja mitos e verdades sobre o uso do Viagra no sexo

Há 16 anos o Viagra foi lançado para ajudar os homens que sofrem de disfunção erétil e mudou o mundo das vítimas de impotência sexual . Ainda hoje, porém, há muitos mitos entre as verdades sobre o uso da medicação. Veja o que já foi comprovado e o que não passa de lenda sobre a medicação.

O que Г© fato comprovado sobre o Viagra

Entre as verdades sobre o uso do Viagra. é possível destacar que pacientes com problemas cardiovasculares podem usar o remédio sem problemas. Portadores de insuficiência cardíaca, pressão alta e outras doenças do coração podem fazer uso do medicamento, desde que prescrito pelo médico.

Além disso, é igualmente verdade que pacientes que usam remédios à base de nitrato não podem tomar medicamento para tratar a impotência. Os nitratos são utilizados por pessoas que tiveram infarto ou angina, e seu uso com comprimidos para disfunção erétil pode resultar em complicações graves .

Outro fato comprovado diz respeito à duração dos efeitos do remédio . entre 4 e 6 horas, o que é adequado para o perfil de hábitos sexuais de muitos casais. No entanto, o princípio ativo do remédio pode ter efeito de até 12 horas para um grande número de pessoas com disfunção erétil .

Também é verdade que o remédio funciona para todos os graus de disfunção erétil, sendo eficaz desde casos leves até os mais complexos, e apresenta boa eficácia independente da causa do problema – seja orgânico ou psicológico.

Outra verdade em relação ao tratamento é que o Viagra não foi inicialmente desenvolvido para tratar de impotência . e sim para angina (baixo abastecimento de oxigênio ao músculo cardíaco). Durante os primeiros estudos, esses pacientes relataram um “curioso efeito colateral ”, que era a ereção quando havia estímulo sexual .

Viagra e suas lendas

Entre os mitos sobre o Viagra. um dos mais comentados é o de que o remédio precisa ser tomado uma hora antes das refeições ou logo após comer. Não há nenhuma mudança na eficácia da medicação com relação à alimentação.

É mito também que o uso juntamente com álcool tem ação retardada. Estudos realizados com homens que beberam uma garrafa de vinho mostraram que não existe interação entre álcool e o remédio. E vale lembrar: o laboratório que produz o medicamento não recomenda o uso conjunto .

Engana-se quem acha que o Viagra perde o efeito com o tempo a longo prazo. Estudos mostraram que, mesmo após anos de tratamento, a ação do medicamento não foi alterada. Além disso, não existem problemas relacionados ao uso frequente do medicamento – a segurança da utilização a longo prazo já foi comprovada.

Por fim, Г© mito afirmar que pessoas com mais de 70 anos nГЈo podem tomar a pГ­lula azul. A verdade Г© que nГЈo existe idade mГЎxima para o uso de Viagra. Todo homem pode utilizar o medicamento para melhorar seu desempenho sexual . desde que seja avaliado previamente pelo mГ©dico.

Gostou do artigo? Qual Г© a sua opiniГЈo sobre ele? Venha compartilhar suas experiГЄncias e tirar suas dГєvidas no FГіrum de DiscussГЈo DoutГ­ssima !

Esclareça as principais dúvidas sobre o uso do Viagra

Remédio contra a disfunção erétil revolucionou o alcance da vida sexual

Quinze anos atrás, em junho de 1998, apenas dois meses após a liberação para o consumo nos EUA, o Viagra começava a ser comercializado no Brasil. Era o fim da busca pela solução de um problema que atormenta os homens desde a antiguidade, e que para a maioria até então não era fácil de ser admitido ou tratado.

Estima-se que mais de 50% dos homens acima de 40 anos sofram com algum problema de impotГЄncia sexual. Antes do surgimento do Viagra e de outros tratamentos orais do tipo, como Cialis e Levitra, as Гєnicas alternativas Г  disfunção erГ©til eram cirurgias dolorosas e supositГіrios traumatizantes – alГ©m de todos os alimentos com fama afrodisГ­aca, como ostras e ovos de codorna. ‘Desde 1998, atГ© hoje, foram comercializados aproximadamente 114 milhГµes de comprimidos sГі no Brasil’, afirma Eurico Correia, diretor mГ©dico da Pfizer no Brasil.

A história do Viagra é fruto de um acaso. Em 1994, cientistas americanas pesquisavam um novo medicamento para o tratamento da angina, uma doença cardíaca. Os resultados foram decepcionantes, porém um dos efeitos colaterais logo chamou a atenção: seus pacientes estavam tendo ereções.

Após confirmar que o citrato de sildenafila presente no remédio causava um aumento da irrigação sanguínea no pênis, os pesquisadores logo redirecionaram seu trabalho para a questão da disfunção erétil. O Viagra seria liberado para consumo em março de 1998 nos EUA. No mês seguinte, 40.000 prescrições da pílula azul estavam sendo emitidas a cada dia pelos médicos americanos.

A seguir, uma lista com explicações médicas sobre mitos e verdades a respeito do produto. Confira:

Pacientes com problemas cardiovasculares nГЈo podem usar Viagra?

Mito. Portadores de insuficiência cardíaca, pressão alta e outras enfermidades relacionadas ao coração podem fazer uso do medicamento, que sempre deve ser prescrito pelo médico. Viagra pode ajudar esses pacientes a retomar ou melhorar a atividade sexual.

Para fazer efeito, o Viagra precisa ser tomado uma hora antes das refeições ou depois de comer?

Mito. Refeições habituais não alteram a absorção do medicamento. Refeições ricas em lipídios (gordura) levam a um retardo na absorção. Entretanto, a eficácia não é alterada (apenas há atraso na absorção e não na eficácia).

Viagra não pode ser tomado com álcool, pois tem ação de efeito retardada?

Mito. Estudos realizados com homens que beberam uma garrafa de vinho mostraram que não existe interação entre álcool e Viagra. Apesar disso, a Pfizer, de maneira responsável, não recomenda o uso concomitante.

Viagra funciona por atГ© 12 horas seguidas?

Verdadeiro. A duração da ação está estimada inicialmente entre 4 e 6 horas, o que é adequado para o perfil de hábitos sexuais de muitos casais. Porém, estudos demonstram que a sildenafila (princípio ativo de Viagra) pode ter efeito de até 12 horas para um grande número de pacientes com disfunção erétil.

Viagra perde o efeito com o tempo a longo prazo?

Mito. Estudos mostraram que, mesmo após anos de tratamento com Viagra, a ação do medicamento não foi alterada.

Quem tem mais de 70 anos nГЈo pode usar Viagra?

Mito. NГЈo existe idade mГЎxima para o uso de Viagra. Todo homem pode utilizar o medicamento para melhorar seu desempenho sexual, desde que seja avaliado previamente pelo mГ©dico.

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What happens when you give a girl viagra

Health related question in topics Medicine Treatment .We found some answers as below for this question “What happens when you give a girl viagra”,you can compare them.

Although Viagra can indeed create the outward signs of arousal in many women, that seems to have little effect on a woman’s More? [ Source: http://www.chacha.com/question/what-happens-when-you-give-a-girl-viagra ]

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What happens when you give girls viagra? http://answers.yahoo.com/question/index?qid=20080923095631AAyTqGz Viagra was first a blood pressure medication – until they realized it had the effect on men that it does. Nothing will happen to her except for a decrease in blood pressure. What happens if a girl takes Viagra? http://answers.yahoo.com/question/index?qid=20090806181521AAhNHzr All Viagra really does is increase blood flow, which is why it works really well for men. It won’t do anything to a girl if she where to take it. What happens when a girl takes Viagra? http://answers.yahoo.com/question/index?qid=20080910202305AAd5Xzi she’d probably get the same side effects as a man who took them minus the erection.

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What happens when a girl uses viagra? Q: Ok this is my friend asking (a guy) but what happens when a girl uses viagra? Show sources if possible. A: Here is the technical answer,Viagra and its derivatives are what is known as Phosphodiesterase (PDE) Inhibitor. Long story short it causes vasodilation to blood vessels which leads to more blood flow. Originally, it's intent was as blood pressure lowering med. It affects many area including the well known effect in fascilitation of an erection for males as well dialating blood vessels in the brain leading to the side effect of headaches. It also has effects on the blood vessels of the eyes as well. It is not a labido enhancing drug with no psychological effects, one must be stimulated sexually in the mind and then the body reacts, Viagra fascilitates the body's response. So the question is for females. Females have similar erectile tissue to men. While it may lead to increased blood flow of the erectile tissue of the pubic region, it doesn't mean the women is sexually aroused. Also the other effects like headaches as well as vision issues. There may be other effects since no large study have looked at Viagra's affects on human females. What happens when you give girls viagra? Q: My girlfriend gave me some viagra, then she took some. Is she going to grow a pair?I can honestly say if she changes gender, we are breaking up. A: Viagra was first a blood pressure medication – until they realized it had the effect on men that it does. Nothing will happen to her except for a decrease in blood pressure. What happens when a girl takes viagra? Q: Just curious about the results. haha. A: You grow a penis and an arm out of your ass.

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РїС—Р…Sustituto natural del Viagra?

Durante 50 aРїС—Р…os se les ha aconsejado a las mujeres que "entrenen" la pelvis para el parto.

Los ejercicios pРїС—Р…lvicos tradicionalmente recomendados a las mujeres tambiРїС—Р…n podrРїС—Р…an resultar beneficiosos para los hombres.

AsРїС—Р… lo afirma un estudio de la Universidad del Oeste de Inglaterra, con sede en la ciudad de Bristol.

SegРїС—Р…n el estudio, los ejercicios resultaron tan РїС—Р…tiles como el Viagra.

SegРїС—Р…n los cientРїС—Р…ficos, ese tipo de ejercicios ayuda a quienes padecen una “disfunciРїС—Р…n erРїС—Р…ctil” casi tanto como el Viagra.

De modo que, en adelante, los hombres podrРїС—Р…an contar con una alternativa natural a la terapia con fРїС—Р…rmacos.

Durante 50 aРїС—Р…os se les ha aconsejado a las mujeres que “entrenen” la pelvis con el fin de fortalecer los mРїС—Р…sculos y prepararlos para el parto.

La pelvis posee una “hamaca” muscular sobre la que descansan los intestinos y la vejiga.

En el caso de los hombres, los ejercicios al parecer fortalecen los mРїС—Р…sculos que rodean al pene y mejoran la irrigaciРїС—Р…n sanguРїС—Р…nea.

En el estudio de la Universidad del Oeste de Inglaterra participaron 55 pacientes con una edad promedio de 59 aРїС—Р…os, que venРїС—Р…an sufriendo de impotencia al menos seis meses antes del inicio de la investigaciРїС—Р…n.

Todos ellos, pacientes del Hospital Somerset Nuffield, realizaron cinco sesiones semanales de ejercicios pРїС—Р…lvicos y fueron controlados a los tres y cinco meses.

La gran diferencia es que se trata de una terapia natural

Sustitutos naturales del viagra

La sandГ­a contiene sustancias que mejoran la vida sexual.

El viagra es un medicamento muy conocido por sus propiedades para mejorar el rendimientos sexual y mantener la erecciГіn. Muchos hombres han sido beneficiados con sus resultados, pero algunos no pueden tomarlo por varias razones. Por eso, muchos han buscado sustitutos naturales para el viagra. AcГЎ te compartimos algunos. ВЎAtento!

SandГ­a: Esta fruta es rica en Citrulina, una sustancia conocida por sus cualidades para mejorar la potencia sexual y la circulaciГіn de la sangre hacia el pene.

Ajo: Muchos le tememos, porque provoca mal aliento. Pero 4 dientes de ajo al dГ­a te darГЎn toda la potencia sexual que necesitas.

Granada: El jugo de esta fruta mejora en un 32% la circulaciГіn de la sangre en el ГЎrea genital. Tomar al menos una onza de jugo de granada te harГЎ sentir potente.

Maca: Es una raГ­z de los Antes que ha demostrado ser la mejor forma de tener erecciones fuertes y durar mГЎs en la cama.

AzafrГЎn: Ayuda a mejorar el desempeГ±o sexual, las erecciones y da energГ­a.

Estos alimentos te ayudarГЎn a tener una vida sexual sana, sin el uso de sustancias quГ­micas.

ВїQuГ© otros sustitutos naturales para el viagra conoces?

te podrГ­a interesar

ВїГљltimamente sientes que te falta la energГ­a y te sientes cansada todo el tiempo? A continuaciГіn te damos algunas posibles causas.

ВїHablas frecuentemente contigo mismo? No, no estГЎs loco, al contrario. De acuerdo con un estudio esto puede ser sГ­ntoma de buena salud y de que tu cerebro funciona mejor.

El vinagre de manzana es muy econГіmico y prГЎctico y tiene muchos usos en el hogar y grandes beneficios para la salud. A continuaciГіn te mencionamos tres beneficios de Г©ste.

Si bien no se ha comprobado que algГєn alimento pueda prevenir el Alzheimer, existen algunos que por sus propiedades pueden reducir el riesgo de padecerlo.

Calidad informativa. Calidad informativa. La mente que se abre a una nueva idea jamas volverá a su tamaño original. Albert Einstein, energia sustentable, Teoriad de Hamer, biogás, neurolingüística, grafología, psicofisiognomia, reiki, yoga, astrologia, musicoterapia, autoayuda, Iridologia, dislexia, sexo, medicina ortomolecular, calentamiento global, cosmobiologia, hipnosis,

24 Noviembre 2010

La Viagra es el nombre comercial del sildenafilo o sildenafil. Este fГЎrmaco fue sintetizado por la empresa Pfizer para su uso en la hipertensiГіn arterial y la angina de pecho, ya que es un potente vasodilatador. Las primeras pruebas indicaron que los efectos en la angina eran ligeros, pero descubrieron que podГ­a inducir notables erecciones de pene.

Por ello, la multinacional farmacГ©utica prefiriГі comercializar este nuevo producto para combatir la disfunciГіn erГ©ctil. La Viagra es patentada en 1996, y aprobada para su uso en EE.UU. en 1998. El Г©xito fue inmediato: las ventas anuales en el periodo 1999-2001 superaron los mil millones de dГіlares.

La dosis mГЎs habitual es 50 mg; no se debe superar los 100 mg y se desaconseja consumir mГЎs de una dosis diaria. Al cabo de los aГ±os, tambiГ©n se ha recetado para el tratamiento de la hipertensiГіn pulmonar.
Las empresas no quieren limitarse al mercado masculino. Los productos farmacГ©uticos para combatir la disfunciГіn sexual femenina son cada vez mГЎs numerosos. Productos como Vagifem, Ovestin, Premarin o Estring se presentan como soluciones contra los problemas sexuales femeninos. Otros productos, como el inhalador Pt 141 (bremelanotide) para activar el deseo sexual femenino se han quedado por el camino. Se ha demostrado que esta sustancia puede provocar hipertensiГіn arterial.

La competencia de Viagra
El gran negocio que abriГі Viagra despertГі pronto la competencia. AdemГЎs de este producto, hoy se comercializan las marcas Levitra y Cialis. Esta Гєltima surte efecto en 30 minutos, y su acciГіn dura hasta 48 horas. Levitra fue protagonista de una polГ©mica. Su productora, la multinacional Bayer, tuvo que retirar una campaГ±a de promociГіn por su tono machista.

Los investigadores siguen trabajando para combatir este problema. La empresa Palatin Technologies estudia una versiГіn sintГ©tica de una hormona, el polipГ©ptido estimulador del melanocito alfa (alfa-MSH), que provoca erecciones en los hombres e incrementa su interГ©s por el sexo. Y Morten Kringelbach, de la Universidad de Oxford, ha desarrollado el primer chip sexual.

La historia nos recuerda que la disfunciГіn erГ©ctil ha preocupado desde siempre. Se ha probado con casi de todo: la ingestiГіn de testГ­culos de toro o la cantГЎrida, un insecto que se ingiere en polvo. Se cuenta que Fernando el CatГіlico, ya viudo, tomГі esta Гєltima sustancia para dar la talla con su joven esposa Germana de Foix.

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РїС—Р…CuРїС—Р…l es la dosis ideal de Viagra?

Me tomo 25 mg en ayunas con un vaso grande de agua a las 08:00 hrs. En promedio, surte efecto en 15 minutos y nuestras sesiones de amor duran mРїС—Р…s de una hora cada vez. -65 aРїС—Р…os, Florida.

DecidРїС—Р… probar una pРїС—Р…ldora de Viagra de 25 mg. SentРїС—Р… que el pene se me ponРїС—Р…a duro al cabo de 15 minutos. Se vuelve mРїС—Р…s duro que de costumbre y tambiРїС—Р…n dura mРїС—Р…s. РїС—Р…YT, 45 aРїС—Р…os, Nigeria.

Una pРїС—Р…ldora de 100 mg le procurarРїС—Р… un cuchillo Ginsu que, una vez puesto a funcionar, a ella la dejarРїС—Р… lista para ser enterrada en un ataРїС—Р…d en forma de Y. Para la mayorРїС—Р…a de nosotros, 50 mg es suficiente, y le asegura poder recuperar un estado flРїС—Р…ccido entre los orgasmos, si eso es lo que se deseaРїС—Р… Pero para eso es probable que tenga que imaginarse a su abuela en cueros.

Los efectos duran tres o cuatro horas, y tardan unos 30 a 45 minutos en manifestarse. Las pРїС—Р…ldoras de 25 mg o 50 mg funcionan indistintamente para mРїС—Р…. AtrРїС—Р…vase a probarlo. РїС—Р…Art, 62 aРїС—Р…os, Texas.

ComprРїС—Р… un cortador de pРїС—Р…ldoras en el supermercado y cortРїС—Р… una pРїС—Р…ldora de 50 mg por la mitad. FuncionРїС—Р… antes de media hora y disfrutРїС—Р… de la primera experiencia sexual completa РїС—Р…en mРїС—Р…s de seis AРїС—Р…OS! -William, 42 aРїС—Р…os, Texas.

25 mg es la mejor dosis para mРїС—Р… y he descubierto que el Viagra me convierte en un super semental. Mi chica se monta encima y siempre tiene uno o dos orgasmos. РїС—Р…Pablo, 42 aРїС—Р…os, Texas.

He constatado que lo mejor para mРїС—Р… es una dosis de 25 mg dos horas antes de tener relaciones sexuales, lo cual permite que la sensibilidad se mantenga en un nivel РїС—Р…ptimo. Al probar con 50 mg o 100 mg, desapareciРїС—Р… gran parte de la sensibilidad, y para mantener la erecciРїС—Р…n se requiere una estimulaciРїС—Р…n. Desde luego, en mi caso mРїС—Р…s no es sinРїС—Р…nimo de mejor. РїС—Р…Phil, 60 aРїС—Р…os, California.

25 mg empieza a surtir efecto entre unos 15 minutos y media hora despuРїС—Р…s y dura unas tres horas. Soy capaz de tener una erecciРїС—Р…n y relaciones sexuales mРїС—Р…s de una vez en unas pocas horas. -65 aРїС—Р…os, Nueva York.

Mi mРїС—Р…dico me prescribiРїС—Р… Viagra de 50 mg. РїС—Р…Vaya! Una erecciРїС—Р…n inmediata que dura un buen rato. Tomo 50 mg unas tres veces a la semana.

He probado las dosis de 100 mg de vez en cuando, pero en realidad me va mejor con las dosis mРїС—Р…s pequeРїС—Р…as. РїС—Р…JR, 65 aРїС—Р…os.

Hay que experimentar con diferentes dosis e intervalos de tiempo. Yo empecРїС—Р… con 50 mg (adecuado para estimular mi organismo, creo) pero con el tiempo he descubierto que lo ideal para mРїС—Р… es una dosis de 25 mg unos 90 minutos antes de tener relaciones sexuales. Las dosis mРїС—Р…s pequeРїС—Р…as significan menos congestiРїС—Р…n nasal y mРїС—Р…s sensibilidad durante el coito. Pero la dosis de 25 mg todavРїС—Р…a me mantiene duro como una piedra y capaz de contener el orgasmo prРїС—Р…cticamente hasta cuando quiero.

He experimentado con diferentes dosis y he descubierto que 25 mg una media hora antes de tener relaciones sexuales es perfecto para mРїС—Р…. Se me pone dura como una piedra y puedo durar una eternidad.

Le pido al farmacРїС—Р…utico que me parta una dosis de 100 mg en cuatro dosis de 25, que es lo que tomo cada vez. Cuando quiero que dure toda la noche, me tomo los 100 mg.

Yo parto las pРїС—Р…ldoras de 50 mg por la mitad y con eso me basta.

Nos corrimos juntos, y РїС—Р…madre mРїС—Р…a. quРїС—Р… manera de correrse. РїС—Р…QuРїС—Р… potencia! Lo que hace de esta experiencia algo cada vez mejor es que sРїС—Р…lo utilizo la mitad de una dosis de 50 mg.

Yo comencРїС—Р… con una dosis de 25 mg. Y la he reducido a 12,5 mg (parto la pРїС—Р…ldora de 100 mg en 8 trozos) y he descubierto que con esta dosis reducida, puedo seguir teniendo una erecciРїС—Р…n durРїС—Р…sima asРїС—Р… como un dolor de cabeza muy ligero.

He llegado a descubrir que sРїС—Р…lo necesito 25 mg para tener y conservar una erecciРїС—Р…n. Pero, la primera noche tomРїС—Р… 50 mg. РїС—Р…Bill, Chicago, 42 aРїС—Р…os.

CРїС—Р…mo tomar Viagra

EL VIAGRA ROSA
A partir de la aparición del citrato de sildenafil (Viagra –VGR-) eficaz medicamento para la impotencia, hacen también su aparición, los llamados “Viagras vegetales o naturales” y los “Viagras femeninos”

A DIECISIETE AÑOS DEL SILDENAFIL
En 1998 se presentó la medicación oral para la disfunción eréctil conocida como Viagra (citrato de sildenafil). ¡Sepamos más de este medicamento que revolucionó el mundo!

Sildenafil en toma diaria
Les enumeramos las ventajas e indicaciones de esta novedosa forma de administración que consiste en tomar 25mg de sildenafil cotidianamente en lugar de la tradicional toma a demanda 1 hora antes de la relación sexual

el sildenafil: Mejora el rendimiento?
polémico articulo sobre el uso recreacional del Viagra, ante su utilización -cada vez mas en aumento- por personas que no padecen de disfuncion erectil.

el Viagra y las erecciones nocturnas
U ltimas y recientes investigaciones refieren que, varones sin disfunción eréctil, mejorarían su respuesta erectiva, tomando Viagra cada noche.

otros factores de riesgo de disfunción eréctil y el Viagra
e l alcoholismo, la vida sedentaria, el tabaquismo, pueden predisponer a una impotencia por distintos mecanismos. En este artículo se lo explicamos, así como también las posibilidades de recuperación de la función sexual.

obesidad, disfunción eréctil y el Viagra
la obesidad puede predisponer a una impotencia por distintos mecanismos. En este artículo se lo explicamos, así como también las posibilidades de recuperación de la función sexual.

disfuncion erectil, dislipemias y el viagra
las dislipemias (colesterol total y trigliceridos altos) se asocian frecuentemente a enfermedades vasculares generalizadas dentro de las cuales la impotencia tiene una alta prevalencia.

versiГіn impresa ISSN 0034-9887

Rev. mГ©d. Chile v.127 n.11 Santiago nov. 1999

http://dx.doi.org/10.4067/S0034-98871999001100016

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Recomendaciones para el uso del
Sildenafil en pacientes cardiópatas

Recommendations for the use of
Sildenafil in patients with cardiac
diseases

S r. Editor. El Sildenafil (Viagra®) ha demostrado ser una importante ayuda para pacientes portadores de disfunción eréctil. Dada las implicancias de su utilización en el área cardiovascular, hemos estimado de interés entregar al medio médico chileno, recomendaciones que faciliten su adecuada indicación y administración.

Es conocida la coincidencia entre los factores de riesgo de disfunción eréctil y enfermedad coronaria y, con gran frecuencia, esta disfunción se presenta en individuos portadores de hipertensión arterial, diabetes, dislipidemias, fumadores, coronarios o sólo con edad avanzada.

Su administración puede asociarse a riesgo cardiovascular a través de dos caminos:

1. Cuando un individuo con factores de riesgo cardiovascular o portador de cardiopatía conocida y sedentario, queda en condiciones de reiniciar o aumentar la frecuencia de relaciones sexuales, la mayor demanda de oxígeno por el miocardio puede superar una reserva coronaria disminuida, llevando a isquemia miocárdica y al riesgo de arritmias por la descarga simpática.

2. Teniendo el Sildenafil un leve efecto hipotensor, y un importante efecto potenciador del efecto vasodilatador de los nitritos, tanto de uso agudo como crónico, existe el riesgo de desencadenar graves episodios de hipotensión si se administran a un paciente ambos tipos de drogas.

Con la información disponible hemos llegado en acuerdo a lo siguiente:

- En la indicación del Sildenafil (Viagra®), la evaluación cardiológica debe considerarse en cualquier individuo mayor de 45 años, en especial en aquellos que no realizan actividad física, los enfermos cardíacos y además todos aquellos que tengan algún estigma arterioesclerótico.

- Se considera de interés que el médico conozca el perfil psicológico del paciente, sus expectativas y forma de vida, a fin de ver en qué perspectiva se usará el fármaco.

- En individuos < 45 años, sin factores de riesgo, se puede indicar sin necesidad de evaluación cardiovascular.

- Evaluar previo a su uso a todo individuo portador de factores de riesgo cardiovascular (edad: > 45 años; hábito tabáquico (sin importar cantidad); hipertensión arterial; dislipidemias; diabetes mellitus (esté o no compensada); antecedentes familiares de enfermedad coronaria precoz; sedentarismo; obesidad; o electrocardiograma con hipertrofia ventricular izquierda).

Se recomienda evaluación cardiovascular en :

1. Individuos < 45 años, sin factores de riesgo, pero muy sedentarios: recomendamos efectuar prueba de esfuerzo logrando al menos un trabajo equivalente a 7 mets (6 min del protocolo de Bruce o similar). Si el resultado fuera anormal, deberá procederse a un estudio cardiológico más completo antes de autorizar el uso del fármaco.

2. Personas presuntas sanas, con uno o más factores de riesgo: Conducta similar a la del punto 1. Es deseable que en la prueba de esfuerzo se alcance como mínimo la frecuencia submáxima.

3. Pacientes coronarios estables

Se recomienda realizar test de esfuerzo, manteniendo la terapia habitual (que no debe incluir nitritos) llegado a menos a 7 mets.

Si fuera positivo precoz (menor de cinco min), no es recomendable la utilización del fármaco y el paciente debe someterse a los estudios habituales de isquemia miocárdica. Aquellos pacientes que no pueden realizar un test de esfuerzo, deben hacerse pruebas de evaluación de isquemia con otros métodos, tales como medicina nuclear o ecocardiografía de stress.

En pacientes con angina inestable, está absolutamente contraindicado.

4. Pacientes con insuficiencia cardíaca

Los pacientes que estén en capacidad funcional I o II y que logren realizar 7 mets de esfuerzo, bajo su terapia habitual, no necesitan mayor evaluación para autorizar su uso. En caso de pacientes con capacidad funcional III y IV, está contraindicado aunque se esté administrando terapia completa. Si la insuficiencia cardíaca tiene riesgo de hipotensión (PA sistólica <110 mmHg), no es recomendable su administración por el riesgo de acentuarla. Dado los riesgos de ortostatismo, es importante conocer la posición en que se midió la presión arterial. Para mayor aclaración puede realizarse una monitorización ambulatoria de presión arterial (MAPA).

5. Pacientes con arritmias

5.1. Arritmias supraventriculares. En caso de taquicardias supraventriculares, fibrilación auricular senil o flutter auricular de frecuencia rápida, bien controladas por medicamentos, puede indicarse Viagra® con precaución, siempre que estos pacientes sean capaces de alcanzar los 7 mets en el test de esfuerzo. Si estas arritmias se asocian a frecuencia rápida, compromiso hemodinámico o presíncope, debe evitarse.

5.2. En caso de síndrome de preexcitación con arritmias "malignas", está contraindicado.

5.3. Arritmias ventriculares. En pacientes con arritmias ventriculares, con terapia antiarrítmica exitosa y con buena capacidad funcional clínica o medida por test de esfuerzo, puede autorizarse su uso.

En arritmias ventriculares complejas en pacientes coronarios conocidos, con insuficiencia cardíaca o que presentan síncope, no debe ser utilizado.

6. Hipertensión arterial

En pacientes hipertensos controlados, sin cardiopatía y eventualmente con prueba de esfuerzo normal, puede usarse. Los pacientes de bajo o mediano riesgo según el VI Informe del Joint National Committee, que tengan prueba de esfuerzo normal, no tienen contraindicación para usarlo. Aquellos del grupo de alto riesgo deben estudiarse previamente por MAPA y el riesgo estará dado por hipertensión reactiva o por hipotensión producida por el uso de drogas hipotensoras.

7. Tratamiento del infarto agudo y angina inestable en pacientes que utilizan Viagra® en las 24 h previas

Las medidas terapéuticas son las habituales, con excepción del uso de nitritos en las siguientes 24 h. Es posible utilizar Diltiazem i.v. en su reemplazo. En el caso que los pacientes hayan recibido nitritos, deben tratarse con el esquema propuesto por la American Heart Association, que fundamentalmente consiste en la administración importante de volumen y drogas vasoactivas.

8. Pacientes hipotensos o disautonómicos. Puede ser utilizado con especial precaución en individuos ancianos, con hipotensión postprandial o con Tilt-Test (+). No debe indicarse en casos de síncope neurocardiogénico maligno.

9. Grupo Misceláneo: No existe contraindicación en indicarlos en pacientes con hipertrofia septal asimétrica, miocardiopatía hipertrófica, o valvulopatías con buena capacidad funcional.

Dres. Carlos Akel A, Hernán Prat M, César Carranza V, Hernán Chamorro B, Hernán Zárate M, Héctor López B, Mario Hassi T, Alejandro Forero A, René Asenjo G, Manuel Pinto S y Patricio Marró F.

1. GOLDSTEIN J, LUE TF, PADMA/NATHEM H, ROSEN RC, TEERS WD, WICKER PA. Oral sildenafil in the treatment of erectile dysfunction. N Engl J Med 1998; 338: 1397-4. [ Links  ]

2. MORALES A, GINGELL C, COLLINS M, WICKER PA, OSTERLOH IH. Clinical safety of oral sildenafil citrate (Viagra) in the treatment of erectile dysfunction. Int J Impot Res 1998; 10: 69-74. [ Links  ]

3. DRORY Y, SHAPIRA J, FISMAN E, PINES A. Myocardial ischemia during sexual activity in patients with coronary artery disease. Am J Cardiol 1995; 75: 835-7. [ Links  ]

4. MULLER J, MITTLEMAN M, MACLURE M, SHERWOOD J, TOFLER G. Triggering Myocardial infarction by sexual activity. JAMA 1996; 275: 1405-9. [ Links  ]

5. DRORY Y, FISMAN EZ, SHAPIRA Y, PINES A. Ventricular arrhytmias during sexual activity in patients with coronary heart disease. Chest 1996; 109: 922-4. [ Links  ]

6. Summary statement of the American College of Cardiology and the American Heart Association on the use of Sildenafil (Viagra) in patients at clinical risk from cardiovascular effects. August 10, 1998. www.americanheart.org/what ews/AHA science Advisories/viagra.htlm. [ Links  ]

7. PRIETO JC. Sildenafil (Viagra) en la hora de las advertencias (Editorial). Rev Méd Chile 1998; 126: 1285-7. [ Links  ]

Bernarda MorГ­n 488, Providencia,
Casilla 168, Correo 55
Santiago – Chile

Tel. (56-2) 2753 5520

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How men can perk up their virility WITHOUT Viagra

By Anna Hodgekiss
Updated: 23:21 GMT, 23 May 2011

Last week, British researchers revealed impotence drugs such as Viagra might cause sudden hearing loss — which is worrying news for the estimated 2.3 million men in Britain who suffer from erectile dysfunction.

It is thought that a chain of chemical reactions triggered by Viagra may affect the inner ear.

Though erectile dysfunction is more common in older men — around 65 per cent of the over-60s suffer from it — around 40 per cent of men will have suffered from the problem by the age of 40.

There are an estimated 2.3 million men in Britain who suffer from erectile dysfunction – around 40 per cent of men will have suffered from it by the age of 40

There are many physical causes for it, explains Dr Arun Ghosh, a GP specialising in sexual health at the Spire Liverpool Hospital.

It can be caused by nerve damage from diabetes, or surgery for prostate cancer.

Another cause is reduced blood flow due to smoking, raised cholesterol levels or high blood pressure. Common medications such as anti-depressants and blood pressure tablets can also hamper performance, as can stress and even regular cycling.

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Dr Ghosh says the problem is also closely bound up with flagging libido: ‘A lot of these men are suffering from testosterone deficiency syndrome, due to reaching their 40s and putting on weight around the stomach.

‘This causes testosterone levels to drop, resulting in a loss of libido and erectile function. It’s worth asking for a blood test if you hit 40 and start developing these symptoms.’

As well as the problem of mechanics, there is a psychological component to erectile dysfunction.

Last week, British researchers revealed impotence drugs such as Viagra might cause sudden hearing loss

‘If you’ve had a problem even once before, then you’re always going to be worried it will happen again,’ explains Dr Ghosh.

‘In fact, one of the main roles of any treatment is to give men a psychological boost. It’s vitally important to use treatment alongside some kind of sexual counselling or therapy, even if the cause is due to something physical such as diabetes.

‘A man’s partner will often say: “Don’t worry about it” — but even if he’s trying not to think about his performance, he will think about not thinking about it. And before you know it, performance anxiety has kicked in.

‘Anxiety and stress stop the pituitary gland secreting the hormones needed for sex. The body goes into “fight or flight” mode, shutting down all non-essential functions — with sex being one of them.’

With the latest news about Viagra, many will be tempted to try other options. So what are the best alternatives, whether bought over-the-counter or prescribed by your doctor?

We asked the leading experts for their views on the pills, potions and gadgets that promise to pep up a man’s libido or assist with erectile dysfunction. We then rated them.

INJECTIONS

You inject the drug Caverject into the spongy parts of the penis (on either side at the base)

CONTAIN: The drug Caverject or Viridal Duo (alprostadil).

You inject the drug into the spongy parts of the penis (on either side at the base).

This prescription-only treatment works by preventing blood from leaving after it flows into the penis, creating an erection.

An erection occurs after about 15 minutes and then lasts for 30 to 45 minutes.

EXPERT COMMENT: ‘Understandably, a lot of men are daunted by this, but it can be a very effective treatment, even in men with extreme nerve damage after diabetes or surgery,’ says Dr Ghosh.

‘The needle is tiny and your doctor will show you how to use it the first time. After that, you just self-administer at home.

‘There are complications — sometimes the penis can become bent if you inject too much into one side, or the erection will not subside.

‘But on the plus side, injections are good if you have no libido as you don’t need to be aroused for them to work. However, you still need to seek psychological help to address that aspect.’

HERBAL REMEDIES

Male mice given a ginseng extract displayed an increased amount of sexual behaviour

GOLDEN GINSENG

ВЈ7.95 for 200ml, drinkherbaltea.co.uk

CONTAINS: Ginseng root.

May help erectile dysfunction and low libido by boosting testosterone levels, according to a study published in the Journal Of Sexual Medicine.

Male mice given a ginseng extract displayed an increased amount of sexual behaviour.

A second study of 28 women given either a ginseng capsule or placebo found the former group had ‘significantly elevated arousal levels’.

EXPERT COMMENT: ‘I don’t believe there is any such thing as a herbal aphrodisiac, so you’re better off saving your money,’ says David Colquhoun, professor of pharmacology at University College London.

‘Animal studies are irrelevant for this sort of thing, because men are not mice (especially when it comes to things like libido, with complicated psychological elements). The other trial was small and has not been replicated.’

PRELOX TABLETS

ВЈ36.76 for 60, Boots

CONTAINS: L-Arginine and pycnogenol

L-Arginine is an amino acid found in many foods; pycnogenol is a combination of antioxidants from tree bark. The interaction between these two is said to help maintain healthy blood vessels (L-Arginine specifically has been shown to increase the production of nitric oxide, important for blood flow). Take two tablets twice a day.

EXPERT COMMENT: L-Arginine is found in all proteins and isn’t shown clearly to be a cure for anything whatsoever, says Professor Colquhoun. However, it can lower blood pressure or negatively affect people with allergies.

A U.S. report warned against taking the supplement with drugs such as Viagra as both can lower blood pressure, leading to dangerously low levels.

The same report found there was insufficient evidence on the effectiveness of pycnogenol, whether used alone or in combination with L-arginine.

PRESCRIPTION DRUGS

Cialis works by relaxing the blood vessels, allowing blood flow for an erection

Viagra is one of a group of drugs known as PDE5 inhibitors. If you want to avoid Viagra, other options include tadalafil (brand name Cialis) and vardenafil (Levitra).

They work by relaxing the blood vessels, allowing blood flow for an erection.

EXPERT COMMENT: These drugs are good in that they address both the physical and psychological cause of erectile dysfunction, says Dr Ghosh.

‘Taking one will give you more confidence and, providing you’re in the mood and there’s foreplay, it’ll help physically, too (the drugs need these to work).

‘I tend to prescribe Cialis the most because, unlike Viagra, it’s not affected by fatty food or alcohol. Viagra is an older drug and has a different coating that doesn’t break down so well in the stomach, especially where’s food in there as well.

‘The effects of Cialis last for up to 24 hours, so there’s not so much pressure to perform in a given time frame, whereas with Viagra you only have an hour-long window.

‘It’s been found that giving diabetics or other men with poor blood flow to the genitals a low dose (2.5mg) of Cialis daily can actually help improve blood flow to the area generally, so the next time they take the full dose (10mg) their erections are stronger.

‘I also believe Levitra is better than Viagra — again, because it lasts for 24 hours.

‘However these drugs are unsuitable for men with angina or very high blood pressure. Side-effects include heartburn, nausea and headaches.’

TESTOSTERONE PATCHES AND GELS

Testim is usually applied to a large area of skin, such as the chest or thigh

CONTAINS: 1 per cent testosterone.

Low libido and erectile dysfunction can be treated with testosterone therapy, available in various forms such as tablets, patches and gels — but only on prescription.

The most commonly prescribed products include Testim and Testogel gels. These are usually applied to a large area of skin, such as the chest or thigh.

EXPERT COMMENT: ‘The andropause — or male menopause — is a recognised cause of low libido and erectile dysfunction,’ says Suks Minhas, consultant urologist at University College Hospital London.

‘There have been concerns that giving a testosterone supplement such as a gel may increase the risk of prostate cancer, but the latest research suggests this may not be the case. These gels can be very effective.’

DEVICES

VACUUM PUMPS

These are available on prescription or over-the-counter in pharmacies.

A plastic cylinder goes over the penis and a battery pump or hand pump is used to create a vacuum. This draws blood into the penis; the blood is kept in place with a ring to stop it flowing out.

Vacuum pumps are often used in conjunction with prescription drugs (PDE5 inhibitors) after surgery for prostate cancer, but a pump can be used on its own if the drugs have no effect or there is no nerve function left.

EXPERT COMMENT: ‘This is a good option for people who can’t take drugs such as Cialis, are allergic to the medicine in tablets or injections, or who simply want a drug-free alternative,’ says Dr Ghosh.

‘Be careful not to use it for more than 30 minutes, though, or you could damage the tissues and blood vessels, or cause a blood clot to form. Between 30 and 80 per cent of men find it effective.’

RUBBER RING

This is placed at the base of the penis to stop blood flowing out once erection has been achieved. Available from pharmacies.

EXPERT COMMENT: ‘These do work and can be helpful for men with premature ejaculation, or for older men who find their erections aren’t as strong as they used to be, says Dr Ghosh.

‘They can also be very successful for those with mild erectile dysfunction, who find they can get an erection but can’t sustain it. They are cheap and easily available. I’ve even seen some in Tesco.

‘Be careful not to wear the device for more than 30 minutes, though, or you may cause tissue damage.’

PELLETS

The drug alprostadil stops the blood flowing out of the penis so that it gradually gets bigger

CONTAINS: The drug alprostadil.

The same drug used in the injections is also available in pellet form. Inserted by the man or his partner into the urethra using a disposable applicator, the pellet melts and is absorbed into the body.

It stops the blood flowing out of the penis so that it gradually gets bigger. An erection should follow within five to 15 minutes, and last between 30 and 60 minutes.

EXPERT COMMENT: ‘Some people prefer the idea of these to an injection,’ says Dr Ghosh. ‘But on the whole, they don’t provide such strong erections as the injections and tend not to last as long, because injections target the exact spot. You also need to be careful inserting them as they can cause blockages in the urethra, interrupting urine flow.

‘Side-effects include dizziness, headache and localised pain in the penis or surrounding area.’

SURGICAL TREATMENT

Two cylinders are placed either side in the tissue and these are connected to a pump in the scrotum

These are typically a last resort. The one most often used involves an inflatable device.

Two cylinders are placed either side in the tissue and these are connected to a pump in the scrotum. Squeezing the pump fills the cylinders with fluid kept in a reservoir in the abdomen.

EXPERT COMMENT: ‘This tends to be used by men with serious spinal injuries or those with very bad diabetes (where all the blood vessels have gone), who still want to maintain a sex life,’ says Dr Ghosh.

‘It can be very successful and save sexual relations when all else has failed. There are some risks attached to the operation, though, including infection and damage to the penis.’

Information: Sexual Advice Association: 020 7486 7262 (helpline) or sexualadviceassociation.co.uk

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Common use

The main component of Viagra is Sildenafil Citrate.
Sildenafil Citrate affects the response to sexual stimulation. It acts by enhancing smooth muscle relaxation using nitric oxide, a chemical that is normally released in response to sexual stimulation. This smooth muscle relaxation allows increased blood flow into certain areas of the penis, which leads to an erection.
Sildenafil Citrate is applied for the treatment of erectile dysfunction (impotence) in men and pulmonary arterial hypertension.
Sildenafil Citrate may also be used for other purposes not listed above.

Dosage and direction

Usually the recommended dose is 50 mg. It is taken approximately 0,5-1 hour before sexual activity. Do not take Viagra more then once a day.
A high fat meal may delay the time of the effect of this drug.
Try not to eat grapefruit or drink grapefruit juice while you are being treated with Sildenafil Citrate .

Precautions

Before you start taking Sildenafil Citrate. tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies.
Aged people may be more sensitive to the side effects of the drug.

Viagra is contraindicated in patients who take another medicine to treat impotence or using a nitrate drug for chest pain or heart problems.
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Wednesday through Saturday evenings at 8:00 pm with a Thursday matinee at 2:00 pm.

TICKET PRICES

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Adults: $25
Seniors: $20 (65 or older)
Students (HS & under): $10

Friday & Saturday
Adults: $30
Seniors: $25 (65 or older)
Students (HS & under): $10

FLEX PASS

Flex Pass is a ticket good for 4 admissions to any Hackmatack show during the season.
Adults: $100
Seniors: $80 (65 or older)
Click here to purchase Flex Pass

CONTACT INFO

Tickets can be purchased online. Please note all tickets purchased online are subject to a third party processing fee. To avoid this fee, tickets can be reserved by calling the box office.

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Hackmatack Playhouse was founded in 1972 by S. Carleton Viagra Prova Gratis. He envisioned a summer stock theatre that would showcase the talents of professional and developing thespians from the regional area.

Many theatre goers have called Hackmatack one of New England’s most charming and quaint summer theatres. Some have even said that summer in Maine is not summer without a trip to Hackmatack. Much of the allure of this playhouse is its scenic location and historical presence.

Hackmatack Playhouse is located on the Viagra Prova Gratis family farmstead. The property was purchased by the first Viagra Prova Gratis (then Gubtail) to make the long trip to “New England” from native British Isles in the mid 1600’s. Thomas Viagra Prova Gratis built the first home, a log house which sat in the far left of the present day field overlooking the irrigation pond. According to family legend, this home was burnt down by Indians during one of the many raids on the Salmon Falls river region. The present day farmhouse was constructed between the years of 1716-2005 to appease the needs of an ever-changing diverse and dynamic Viagra Prova Gratis family. When it was first constructed, the house was a large cape sitting endwise to the road. It was occupied at one point by two Viagra Prova Gratis brothers. The younger brother decided that he would like to have a modern two story cape. His older brother in typical conservative fashion said “the house is plenty good enough the way it is”. The younger brother replied, “My half is coming off”. He then proceeded to saw his half off and tear it down. He built his family a two story cape on the end of the original house, parallel to the road, giving the house its shape. Minor reconstructions have taken place since then to create a more modern and functional house for the present day Viagra Prova Gratiss.

Prior to the year of 1972 when the theatre was established, the Viagra Prova Gratis family farm functioned like many other farms at the time. The barn was the focal point of the farm. The current barn has an interesting story much like the original house. One of the first barns was struck by lightning and burned in July of 1934. Haying had just been completed for the season, and it is thought that the heat from the newly cut hay attracted the lightning. Almost immediately, Lewis Viagra Prova Gratis began looking for the right barn to replace what had been lost. He finally purchased a barn. It was a large old structure with pegged timbers measuring fifty four feet long and forty two feet wide. It was the perfect replacement for the old barn. However, there was one small problem, it was located across the street.

Luckily, the Viagra Prova Gratis’s have always been known for their ingenuity. It was with this cleverness that Lewis decided it would be easier to move the barn rather than disassemble it and rebuilt it. The entire barn was jacked up and rollers were placed underneath it. A cable was attached to one end of the barn that ran though a large turnstile. An old white horse was chosen for the job of slowly moving the barn. The horse was hitched to the turnstile and the horse walked in circles, stepping over the cable on every lap. The leverage was great and each time the horse made a circle, the barn moved one half inch. Progress was slow. The entire operation took about three days, a day of that was spent crossing Maine route 9. However, in 1934, Maine route 9 was much less traveled, and everyone cheerfully watched or made their own route around the barn.

After the theatre’s first decade the barn was expanded to the structure that you see today. An addition was added to the back, cement was added to form the floor, and the stage was expanded. These changes made room for the 218 seats the theatre houses today. It is rumored that back in 1972 patrons sat on hay bales to watch the show, however the original playhouse actually had seats that were salvaged from a Durham New Hampshire movie theater.

The grounds of Hackmatack Playhouse and the area surrounding the theatre host many other buildings built and used by the Viagra Prova Gratis clan over the years. The yellow family of buildings just south of the theatre (now owned by the Mills family) was originally built by Samuel Viagra Prova Gratis in the early part of last century. Known as the Forget-Me-Not, these buildings housed services for early automobile travelers, including fuel for the autos, and food for the hungry. Visitors could rent a cabin, and if they happened to be staying on a Saturday night, they were in luck. On Saturday night there were always barn dances.

The oldest building on the farmstead is the “woodshed” which is just south of the house. This building dates back to the 1600’s and has been used for many purposes over the years. It has been used as a slaughter house and for drying meat. It now is used for rehearsal space and prop storage.

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The Viagra Prova Gratis family has a long tradition of entertaining locals and summer visitors in the Beaver Dam section of Berwick. Samuel’s weekly barn dances at the “Forget Me Not” were a favorite pastime during the early decades of the 1900’s. His son Lewis, a local and state Grange Master, was also a master of many musical instruments. He had a passion for starting bands and performing in Beaver Dam and across the state of Maine. His son Carleton organized several theatre groups, first at the Beaver Dam grange, and then at his barn now called Hackmatack Playhouse.

Every year thousands of people gather outside the Playhouse with tickets to the summer’s productions. Every year talented actors audition for their chance to perform at Hackmatack Playhouse, and to experience the history and excitement of being part of Hackmatack’s family. The farm and its building have many stories to tell. Perhaps 200 years from now Viagra Prova Gratis great, great grandchildren will be telling this story to aspiring actors nervously waiting for their audition slot, and to friendly crowds waiting to take their seats; of how the barn became home for the Hackmatack Playhouse.

After the death of the founder in 1995, the S Carleton Viagra Prova Gratis Memorial Fund was established to preserve and improve our historical buildings. The fund also is dedicated to advancements of dramatic arts, both for the participant and the community, and to the commitment of providing quality family entertainment and drama at a reasonable price. Contributions are always welcomed. We thank you in advance for helping us secure the future of Hackmatack Playhouse for potential Hackmatackers.

Hackmatack exists because of the generosity of it’s patrons, friends and those that appreciate the theater’s contribution to local culture and community. It is committed to the advancement of dramatic arts and to providing quality family entertainment at a reasonable price.

We ask that you would consider a donation, and thank you in advance.

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La primera vez que lo tomРїС—Р…, habРїС—Р…amos hecho el amor con mi mujer durante la tarde. El Viagra funcionРїС—Р… perfectamente y produjo otra erecciРїС—Р…n en toda regla para nosotros esa noche. La prРїС—Р…xima vez que lo probРїС—Р… fue una hora antes de acostarme. En esa ocasiРїС—Р…n, los resultados fueron todavРїС—Р…a mejores. РїС—Р…Jimmy B. 45 aРїС—Р…os.

He descubierto que tengo que tomarlo al menos 30 minutos antes de tener relaciones sexuales. Mi erecciРїС—Р…n no sРїС—Р…lo es mРїС—Р…s potente sino que tambiРїС—Р…n aumenta notablemente la cantidad y potencia de mi orgasmo.

Lo tomo aproximadamente una hora antes de hacer el amor (que para nosotros significa mРїС—Р…s o menos a mediados de la tarde).

Cuando el mРїС—Р…dico me lo prescribiРїС—Р… la primera vez, me dijo que tardarРїС—Р…a un rato en tener efecto, casi una hora, y que deberРїС—Р…a tener paciencia. AsРїС—Р… que lo tomРїС—Р… y me sentРїС—Р… a esperar. Me sorprendiРїС—Р… ver que ni siquiera tenРїС—Р…a que esperar tanto rato. Al cabo de quince minutos ya estaba listo, y seguРїС—Р… un poco mРїС—Р…s de lo que ella hubiera querido.

30 minutos despuРїС—Р…s de tomar una dosis de 50 mg de Viagra (sin efectos secundarios excepto un ligero dolor de cabeza), y luegoРїС—Р… РїС—Р…BOING! РїС—Р…El pene se me puso tan duro como a los quince aРїС—Р…os! -Richard, 53 aРїС—Р…os, RU.

EmpecРїС—Р… con 50 mg (suficiente para estimular mis motores, creo), pero con el tiempo descubrРїС—Р… que una dosis de 25 mg unos 90 minutos antes de tener relaciones sexuales es lo ideal para mРїС—Р….

Tuve una erecciРїС—Р…n dura como la piedra una media hora despuРїС—Р…s de tomar la pРїС—Р…ldora. -37 aРїС—Р…os. UTA.

CРїС—Р…mo tomar Viagra

Que es el viagra y como funciona

La viagra es un medicamente ampliamente usado para este problema. ¿Cómo funciona exactamente la viagra y cuáles son los resultados? Puede leer aquí. Encuentre información acerca de cómo tomar VIAGRA ® (citrato de sildenafilo). Vea los riesgos y. Debe estar estimulado sexualmente para que funcione. 2. 31 Oct 2013 . La pastilla azul contra la disfunción eréctil se vuelve más discreta. El Viagra de la compañía Pfizer, lanzada en 1998 y que este mes cumple 15. 5 Jun 2009 . falso. pastillas como el viagra que sirve para la ereccion tambien sirve para la. Para que la pastilla funcione bien tienes que estar bien en tus. En este informe te explicamos todo lo que debes saber sobre la Viagra .3. COMO FUNCIONA. ¿Cuánto tarda en hacer efecto? El efecto de Viagra o Herex usualmente se presenta entre los treinta y sesenta minutos, o incluso antes.La Impotencia es la incapacidad de obtener o mantener una erección adecuada para el coito. No es una enfermedad, sino un efecto secundario, un síntoma de. 6 Jun 2012 . Alrededor de la pastilla azul que le ha devuelto la virilidad a hombres, y la felicidad a mujeres, se tejen muchos mitos. Los expertos resuelven. 19 Ago 2015 . Las autoridades estadounidenses acaban de dar luz verde al primer medicamento específico para tratar la falta de deseo sexual femenino.Una experiencia con el Viagra narrada por un protagonista parecía que iban a funcionar me sentía más seguro y un día tuve una relación bastante buena. .

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En este informe te explicamos todo lo que debes saber sobre la Viagra .3. COMO FUNCIONA. ¿Cuánto tarda en hacer efecto? El efecto de Viagra o Herex usualmente se presenta entre los treinta y sesenta minutos, o incluso antes.La Impotencia es la incapacidad de obtener o mantener una erección adecuada para el coito. No es una enfermedad, sino un efecto secundario, un síntoma de. 6 Jun 2012 . Alrededor de la pastilla azul que le ha devuelto la virilidad a hombres, y la felicidad a mujeres, se tejen muchos mitos. Los expertos resuelven. 19 Ago 2015 . Las autoridades estadounidenses acaban de dar luz verde al primer medicamento específico para tratar la falta de deseo sexual femenino.Una experiencia con el Viagra narrada por un protagonista parecía que iban a funcionar me sentía más seguro y un día tuve una relación bastante buena. La viagra es un medicamente ampliamente usado para este problema. ¿Cómo funciona exactamente la viagra y cuáles son los resultados? Puede leer aquí. Encuentre información acerca de cómo tomar VIAGRA ® (citrato de sildenafilo). Vea los riesgos y. Debe estar estimulado sexualmente para que funcione. 2. 31 Oct 2013 . La pastilla azul contra la disfunción eréctil se vuelve más discreta. El Viagra de la compañía Pfizer, lanzada en 1998 y que este mes cumple 15. 5 Jun 2009 . falso. pastillas como el viagra que sirve para la ereccion tambien sirve para la. Para que la pastilla funcione bien tienes que estar bien en tus.

Porque hay muchas razones las que pueden ser causa de los problemas de sus funcionews sexuales y por consecuente el tratamiento debe ser apropiado para cada caso. ВїCon quГ© rapidez funcionaelViagra. Yo tomo 50 mg 15 minutos antes de hacer el amor y ahora puedo dedicar horas a los prolegГіmenos sin preocuparme de que se me. IAlgunas personas creen que la impotencia – un signo de la inevitable envejecimiento del cuerpo masculino y lucha es levitra 100mg levitra genГ©rico en venta inГєtil. GenГ©rico Cialis Soft. Tadalafil 20/40mg. El Cialis Blando GenГ©rico es un medicamento que combina las dos principales caracterГ­sticas importantes para tratar la. Aprenda cГіmofuncionaVIAGRA В® (citrato de sildenafilo). Vea los riesgos y beneficios. Viagra generico es un medicamento que contiene el mismo componente queViagra normal, el sildenafil. Este medicamento tiene los mismos efectos que la pastilla azul. Lea: EE.UU. aprueba la comercializaciГіn de Addyi, el "viagra femenino" Pero hay mГЎs datos que quizГЎ no conocГ­as sobre el polГ©mico fГЎrmaco. Puede conducir al desarrollo de dependencia fisica y psiquica. Este riesgo aumenta con la dosis y la duracion del mismo. Por lo que comentas en tu correo el medico. Id recommend the azithromycin, y otros. En estos casos es necesario hacer una revision medica inmediatamente. El medicamento se debe consumir de acuerdo a las. ВїY si el mГіvil se enfunda en una funda de aluminio. Imagino que serГЎ como sacarle la baterГ­a Вїno. Si se le saca la baterГ­a, Г©sta se estropea Вїes asГ­.

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ВїCon quГ© rapidez funcionaelViagra. Yo tomo 50 mg 15 minutos antes de hacer el amor y ahora puedo dedicar horas a los prolegГіmenos sin preocuparme de que se me. Viagra generico es un medicamento que contiene el mismo componente queViagra normal, el sildenafil. Este medicamento tiene los mismos efectos que la pastilla azul. Puede conducir al desarrollo de dependencia fisica y psiquica. Este riesgo aumenta con la dosis y la duracion del mismo. Por lo que comentas en tu correo el medico. Lea: EE.UU. aprueba la comercializaciГіn de Addyi, el "viagra femenino" Pero hay mГЎs datos que quizГЎ no conocГ­as sobre el polГ©mico fГЎrmaco. Aprenda cГіmofuncionaVIAGRA В® (citrato de sildenafilo). Vea los riesgos y beneficios. Id recommend the azithromycin, y otros. En estos casos es necesario hacer una revision medica inmediatamente. El medicamento se debe consumir de acuerdo a las. ВїY si el mГіvil se enfunda en una funda de aluminio. Imagino que serГЎ como sacarle la baterГ­a Вїno. Si se le saca la baterГ­a, Г©sta se estropea Вїes asГ­. GenГ©rico Cialis Soft. Tadalafil 20/40mg. El Cialis Blando GenГ©rico es un medicamento que combina las dos principales caracterГ­sticas importantes para tratar la. IAlgunas personas creen que la impotencia – un signo de la inevitable envejecimiento del cuerpo masculino y lucha es levitra 100mg levitra genГ©rico en venta inГєtil. Porque hay muchas razones las que pueden ser causa de los problemas de sus funcionews sexuales y por consecuente el tratamiento debe ser apropiado para cada caso.

ВїCГіmo funciona la Viagra?

La Viagra comienza a trabajar una media hora o una hora despuГ©s de su ingesta. Esto depende del usuario y de si realiza una comida antes de la ingesta. Se recomienda tomar Viagra una hora antes de la actividad sexual.

La Viagra permanece activa una media de cuatro horas, pero tambiГ©n depende de la persona que lo utiliza. Esto no significa que tenga durante 4 – 5 horas una erecciГіn. DespuГ©s de un orgasmo y / o pГ©rdida de la estimulaciГіn sexual, la erecciГіn desaparece. Queda mencionar que la Viagra sГіlo ayuda a conseguir una erecciГіn cuando se estГЎ sexualmente excitado. No va a conseguir una erecciГіn espontГЎnea.

Si tiene una erecciГіn dolorosa durante mГЎs de 4 horas, es aconsejable consultar a un mГ©dico.

Viagra original

Tenga en cuenta que utiliza Viagra original (disponible en la tienda online de Dokteronline.com). Viagra original proporcionar el efecto deseado y tambiГ©n evita efectos secundarios peligrosos. Por desgracia, hay muchos proveedores activos de falsa Viagra en Internet, con todos los riesgos que ello conlleva.

Dokteronline.com existe desde 2003 y es una autoridad en el campo de las farmacias en lГ­nea. Nos distinguimos de los demГЎs por ofrecer un servicio profesional al cliente.

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Viagra

GENERIC NAME(S): SILDENAFIL CITRATE

Uses

Sildenafil is used to treat male sexual function problems (impotence or erectile dysfunction -ED). In combination with sexual stimulation, sildenafil works by increasing blood flow to the penis to help a man get and keep an erection.

OTHER USES: This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional.

Sildenafil is also available in other brands and strengths for treating high blood pressure in the lungs (pulmonary hypertension ). Do not take this medication with any other product that contains sildenafil or other similar medications for erectile dysfunction -ED or pulmonary hypertension (such as tadalafil, vardenafil).

How to use Viagra

Read the Patient Information Leaflet provided by your pharmacist before you start taking sildenafil and each time you get a refill. If you have any questions, ask your doctor or pharmacist.

To treat erectile dysfunction -ED, take this drug by mouth as directed by your doctor, usually as needed. Take sildenafil at least 30 minutes, but no more than 4 hours, before sexual activity (1 hour before is the most effective). Do not take more than once daily.

A high-fat meal may delay how quickly the drug begins to work.

The dosage is based on your medical condition, response to treatment, and other medications you may be taking. Be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Tell your doctor if your condition does not improve.

Side Effects

Dizziness. headache. flushing, or stomach upset may occur. Vision changes such as increased sensitivity to light, blurred vision. or trouble telling blue and green colors apart may also occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Sexual activity may put extra strain on your heart. especially if you have heart problems. If you have heart problems and experience any of these serious side effects while having sex. stop and get medical help right away: severe dizziness, fainting. chest/jaw/left arm pain, nausea .

Rarely, sudden decreased vision. including permanent blindness, in one or both eyes (NAION) may occur. If this serious problem occurs, stop taking sildenafil and get medical help right away. You have a slightly greater chance of developing NAION if you have heart disease. diabetes. high cholesterol. certain other eye problems (“crowded disk”), high blood pressure. if you are over 50, or if you smoke.

Rarely, a sudden decrease or loss of hearing, sometimes with ringing in the ears and dizziness, may occur. Stop taking sildenafil and get medical help right away if these effects occur.

In the rare event you have a painful or prolonged erection lasting 4 or more hours, stop using this drug and get medical help right away, or permanent problems could occur.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction. including: rash. itching /swelling (especially of the face/tongue /throat), severe dizziness, trouble breathing .

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Precautions

Before taking sildenafil, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: heart problems (such as heart attack or life-threatening irregular heartbeat in the past 6 months, chest pain/angina, heart failure), stroke in the past 6 months, kidney disease, liver disease, high or low blood pressure. a severe loss of body water (dehydration), penis conditions (such as angulation, fibrosis/scarring, Peyronie’s disease ), history of painful/prolonged erection (priapism), conditions that may increase the risk of priapism (such as sickle cell anemia. leukemia, multiple myeloma ), eye problems (such as retinitis pigmentosa. sudden decreased vision, NAION).

This drug may make you dizzy or cause vision problems. Do not drive, use machinery, or do any activity that requires alertness or clear vision until you are sure you can perform such activities safely. Limit alcoholic beverages.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

This brand of the drug is usually not used in women. During pregnancy, sildenafil should be used only when clearly needed. Discuss the risks and benefits with your doctor.

It is unknown if this medication passes into breast milk. Consult your doctor before breast-feeding.

Interactions

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.

A product that may interact with this drug is: riociguat.

Sildenafil can cause a serious drop in your blood pressure when used with nitrates. A serious drop in blood pressure can lead to dizziness, fainting, and rarely heart attack or stroke. Do not use sildenafil with any of the following: certain drugs used to treat chest pain/angina (nitrates such as nitroglycerin, isosorbide), recreational drugs called “poppers” containing amyl nitrate, amyl nitrite, or butyl nitrite.

If you are also taking an alpha blocker medication (such as doxazosin, tamsulosin) to treat an enlarged prostate/BPH or high blood pressure, your blood pressure may get too low which can lead to dizziness or fainting. Your doctor may start treatment with a lower dose of sildenafil to minimize your risk of low blood pressure.

Other medications can affect the removal of sildenafil from your body, which may affect how sildenafil works. Examples include azole antifungals (such as itraconazole, ketoconazole), macrolide antibiotics (such as clarithromycin, erythromycin), HIV protease inhibitors (such as ritonavir, saquinavir), hepatitis C virus protease inhibitors (such as boceprevir, telaprevir), mifepristone, rifampin, among others.

Do not take this medication with any other product that contains sildenafil or other similar medications for erectile dysfunction-ED or pulmonary hypertension (such as tadalafil, vardenafil).

Overdose

If overdose is suspected, contact a poison control center or emergency room right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include severe dizziness, fainting, painful/prolonged erection.

Notes

Do not share this medication with others.

Missed Dose

Storage

Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

Information last revised October 2015. Copyright(c) 2015 First Databank, Inc.

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I Took Female Viagra for a Week

I was so over fucking my last boyfriend. We were together for four years and by the third of those my libido was as MIA as he seemed to think my clitoris was. I just couldn’t be bothered, he knew I couldn’t be bothered, even our Chihuahua knew I couldn’t be bothered. I was also on the pill, which can make your body reject the idea of sex entirely (gr8 contraceptive, for realsies).

Towards the end, we literally never had sex, not even when we really hated each other, which is like, the only good time to have sex with anyone. In hindsight, maybe we wouldn’t have had to buy the fucking Chihuahua if I wasn’t so sexually indifferent. It would have given us something to bond over, that wasn’t a tiny, yappy little bitch.

You know what would have made my life a bit easier during those dark years? A big, fat dose of Viagra. If it works for old guys whose dicks are limper than Andy Warhol’s handshake, why shouldn’t it work for me? I spent a week testing out all the different forms of female Viagra I could find, and hoped that at least one of them would turn me into a dribbling, thrusting sex-pest.

DAY 1: Pink Venus Shot – (£4, Ann Summers)

This is a cherry lube flavoured libido shot *shivers*. As well as tasting like underage sex, it contains twice as much caffeine as a cup of coffee, which actually brought on a migraine that – ironically – left me unable to even think about having sex. I guess if giving head turns you on, you can spread it all over your boyfriend and suck away (be careful you don’t get wired and like, chew it off, though).

That’s pretty much the only sexual satisfaction this is going to give anybody. It probably would have been more use if I'd just thrown the shot down the sink and used the tube as a dildo. It made me feel about as sexy as watching one pigeon trying to force-fuck another on the roof of a funeral parlour.

DAY 2: Viafem – (£13.89, Holland & Barrett)

Viafem capsules contain a blend of eight herbs, which apparently increase blood flow and sensitivity to your lady flower. According to their website, you should not take Viafem under any circumstances if you are not in the mood to have sex, the implication being that they turn you into a total nymphomaniac whether you like it or not.

It was an implication that I liked, and after popping a few, I was pumped to go flash my teeth at teenage boys on a light-up dancefloor. Unfortunately, the big night out we'd planned at the Roxy off Oxford Street (it's so easy to get laid at that place I think it must be built on ancient lay lines ;)) was suddenly dashed when, much to my vagina's chagrin, my flatmate decided Two For Tuesday was more important than my sexperiment.

Instead of going on a dick safari, we watched American Pie and I became inexplicably mesmerised by Nadia’s jiggling boobs. As expected, I ended up in bed alone with the horn. I don't think you could blame that on Viafem, though – babes, it wasn't you, it was me.

DAY 3: Gold MAX – (£6.95, Harmony)

Look, not to freak you out or anything, but Gold MAX is fucking intense. I took two capsules before dinner, and without warning my body suddenly screamed YES, and the River Nile was unleashed in my panties. Thanks to GM I had sex for the first time in two months. YAY! My prey described me as being “wetter than an otter's pocket”, which I’m fully taking as a compliment.

Afterwards, he fell asleep and left me writhing around all night trying to "accidentally" wake him by grinding up against him (quite aggressively). It says on the packet that Gold MAX is a Chinese herbal remedy and as such has "no unpleasant side effects", but I got the feeling that if I took it more often it might turn me into a rapist. Which is about as unpleasant a side effect as I can imagine.

Rating: 8.5/10 (-1.5 points for the rapey bit)

Decided I had to try out my rape hypothesis. Didn't rape anyone. Didn't have to, because my new friend let me put some in his tea. Gold MAX, you da best.

DAY 5. Bai He Di Huang – (£10, Natural Wellness London)

The lady in the Chinese medicine shop told me this was for girls only, but she lies. Internet research tells me it’s actually for men, but whatever, gender is a social construct, right? So I took it anyway. I spent my evening working at a 21st birthday party falling in love with beautiful rich kids with no fucking morals – just how I like them. If the amount of cocaine you’re offered determines how many pheromones you’re producing, then I was an actual pheromone, but despite a dozen or so invites to go back to poncy West London after-parties, I decided to go home instead.

At 4AM I was awoken by a phone call from an ex asking to stay at mine because he'd missed the last train home. Curious to test the effects of BHDH, I let him into my bed. Did my general apathy towards this guy dissolve into a sudden and uncontrollable urge to throw a nostalgic fuck party? No. Am I relieved about that? Hell yes, but it doesn't say much about your powers, Bai He Di Huang.

DAY 6. Spanish Fly – (£10, Jonas Bros)

Spanish Fly contains cantharidin, which to you and I is just a scientific name for poisonous beetle piss! Yum! The piss is supposed to irritate your urinary tract and, in doing so, somehow increase your desire for sex. Despite sounding like an ancient torture method, it’s actually one of the world’s oldest and most popular aphrodisiacs – and if it was good enough to make Medieval people who slept in mud and ate their own babies feel sexy, I supposed that it would be good enough for me.

It’s now illegal in most countries, but hey babe, take a walk on the wild side. I went to the pub with my workmates, but I didn’t bark or vomit any blood-streaked membrane over any of them, and my tongue didn’t get furry and covered in boils, either. Disappointing. That would have got me so horny. Spanish Fly was a total let-down; I've had Apple Sourz that worked more effectively. Great packaging, though.

DAY 7: Magnum Tonic Wine (£2.99, every off-license ever)

Wow, this shit is cool. Aside from having the best soundtrack to a video ever, Magnum wine contains alcohol (16 percent) as well as bottled “Sexual Vitality”, which is definitely what the other Viagras have been lacking in. Unfortunately, despite promising to make you Sex Queen of the Dancehall, it tastes like ashes and death, and you have to hold your nose/stomach while drinking it to avoid immediate gagging. Oi oi!

After chugging a few bottles I tried and failed to dagger my flat-mate, made some oven chips, and fell asleep on the sofa.

CONCLUSION: As a result of the pounding caffeine headaches (and unfortunate lack of pounding) I’ve suffered this week, I’m happy to announce that rapey, waterfall-inducing Gold MAX is the clear winner. Go forth and squelch!

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Viagra: How Young Is Too Young?

From the WebMD Archives

Rafael Palmeiro seems an unlikely Viagra pitchman. The Texas Rangers slugger is only 37 and won’t admit to having erection problems, yet he recently agreed to appear in ads promoting the drug. The deal has made people wonder whether Palmeiro really represents men with erectile dysfunction. or whether Pfizer, the company that makes Viagra, wants to persuade young men to try it for fun.

It’s true that erectile dysfunction is more common in older men, but many potential Viagra users are hardly senior citizens: About 40% of 40-year-old men in the U.S. have some degree of erectile dysfunction. Most Viagra users today, according to Pfizer, are in their early to mid 50s. So it makes sense that the company would want to reach more men around Palmeiro’s age.

Urologist Myron Murdock, medical director of the Impotence Institute of America, says these men are likely to use Viagra because sexual performance is a high priority for them.

A younger man, Murdock says, “wants his V-12 Jaguar working just perfectly,” whereas an elderly gent may be content with less dependable erections. What’s more, the sexual partners of younger men “are more demanding of their performance,” Murdock says.

Pfizer denies that it’s promoting Viagra for recreational use. “We’ve consistently opposed that,” says spokesman Geoff Cook. Nevertheless, Murdock says it’s fine to pop the little blue pill to “optimize” your sexual performance.

We assume all young men have normal sexual functioning, “but they’re really not normal,” Murdock says. Hardening of the arteries. which restricts blood flow to the penis. can begin during the teen years, so that by the time a man is in his 20s, his ability to get and keep an erection has already begun to decline. Murdock says many men who seek Viagra for recreational use actually have minor erectile dysfunction.

There’s also some evidence that Viagra can shorten the time it takes a man to recover after sex and be ready for another round. This is called the “refractory period.” Normally it lasts 20 minutes or longer. One study, published in the journal Human Reproduction in January 2000, found that Viagra shortened the refractory period by about 10 minutes in healthy men .

Continued

What Viagra cannot do is increase your sexual appetite or make you ejaculate if you have problems reaching orgasm. Ira Sharlip, urologist in San Francisco, says you shouldn’t expect your erections to reach staggering new proportions, either. “I don’t believe that Viagra can increase an erection beyond 100% of normal,” he says.

“Viagra is a super-safe drug,” Murdock says, assuming you have a healthy heart and don’t take nitrates.

Nitrates include nitroglycerin — a drug that many men take for chest pain from heart disease — and “poppers.” Poppers are little vials of amyl or butyl nitrate. Breaking the vial releases nitrate vapor, which gives a brief high when inhaled. It’s most often used to enhance sexual pleasure, and mostly by gay men. Poppers are not all that safe to use on their own, and they’re especially dangerous when you’re on Viagra.

Nitrates widen blood vessels, and Viagra increases that effect. Mixing the two can cause your blood pressure to drop drastically. A sudden drop in blood pressure can make you pass out, and you may die if your blood pressure stays too low for too long.

Preservatives like sodium nitrate — found in processed food — do not cause this problem, so you won’t die from eating a hot dog while on Viagra. Even so, it’s best to take it on an empty stomach. That way, the drug absorbs into your bloodstream faster. Wine may contain nitrates, but not the kind that cause problems with Viagra. It’s fine to play some Marvin Gaye on the stereo and sip a glass of Chardonnay, if that’s what puts you in the mood.

Although you may be tempted to order Viagra discreetly from one of the hundreds of Web sites that sell it, don’t. “It’s bad medicine,” Murdock says. You really must bring your doctor into your sex life if you want to use Viagra.

When you buy from an online pharmacy, you just have to answer some health questions before you proceed to the checkout page. If you answer honestly — and that might be a big “if” for those determined to get what they want — the questionnaire may catch some possible complications. But the pharmacists who fill your order don’t know your medical history, and no questionnaire can diagnose the root cause of your problem. Erectile dysfunction can have serious underlying causes, like diabetes. heart disease. liver disease, or thyroid disease.

Continued

Cook says Pfizer is opposed to Internet Viagra sales. “Our goal with any of our marketing is simply to reach men and encourage them to see a doctor,” he says.

It seems that Viagra can make sex better for women, too. Like the penis. the clitoris is erectile tissue — spongy tissue that becomes engorged with blood during sexual excitement. By increasing blood flow to the clitoris, Viagra may heighten a woman’s sensation and arousal. It also seems to increase vaginal lubrication.

Murdock says many couples like to heat things up by splitting a dose of Viagra. “It’s an interesting sexual situation,” he says. The recommended dosage for men is up to 100 milligrams per day, and that seems to be just as safe for women. Young people may get results from a smaller dose: As little as 25 mg may be enough.

The FDA has not approved Viagra for women, but Murdock says, “It’s just a matter of time.” He says he and other doctors who specialize in sexual medicine prescribe it to women, which is perfectly legal. Doctors are allowed to use their best judgment. Drug companies, however, can’t advertise any use that isn’t FDA-approved.

The studies being done to test Viagra’s safety and effectiveness in women have shown good results so far. “We’re cautiously optimistic,” Cook says.

Martin F. Downs is a health writer in New York City. He was formerly an editor at CBS HealthWatch. He has also written for Health.com, Salon.com, and POZ magazine and is the editor of the Alicubi Journal (alicubi.com).

В© 2002 WebMD, Inc. All rights reserved.

Growing number of young men are getting addicted to Viagra

Sex therapists say that an increasing number of young men in their 20s and 30s, due to performance anxiety issues, are getting psychologically addicted to Viagra, a medication for treating erectile dysfunction usually prescribed for older men.

According to AlcoholRehab. Viagra (or Sildenafil) is now one of the most widely used drugs in the world and statistics suggest that more than 20 million men have used it. It works by increasing the blood flow to the penis and makes it easier for a man to achieve erection and sustain erection on stimulation.

“More people are. becoming dependent. on the drug. This tends to happen when you have used Viagra for a long period of time and you feel unable to have a healthy sex life without it. It is. possible to become dependent on Viagra when you. are just using it for recreational [purposes]. Viagra is not physically addictive however it is the psychological addiction which can be hard for many men to overcome.”

Many young men who, because of performance anxiety, use Viagra, are embarrassed by the fact and dread having their partners discover that they rely on Viagra to achieve erection. What typically follows is the development of a pattern of secret use and intensification of feelings of shame and guilt that only complicates the psychogenic erectile dysfunction they suffer.

HealthCenter.org lists the signs of dependence:

Using the drug more often and it becoming part of your day to day routine

Missing work or social events due to the effects of Viagra for example extreme fatigue

Having Viagra start to affect your relationship, both sexually and emotionally

Continuing to use Viagra even if you have extreme side effects

Using Viagra daily which can then cause you to become tolerant of the drug and you having to use stronger dosages to see any effect

Buying Viagra when you cannot afford it or getting into debt because of it

Signs of growing abuse of Viagra was reported as early as 2003. AZCentral reported that Dr. Robert Garafolo, director of youth services at the Howard Brown Health Center in Chicago and an adolescent physician, said teenage boys were regularly trying to convince him to writing a prescription for Viagra. According to AZCentra. the drug intended for use by older men with erectile dysfunction problem is now widely used by “hard-partying youth” as a recreational drug.

Dr. Abraham Morgentaler, a Harvard Medical School physician and researcher in sexual dysfunction, said: “College-age students take Viagra to parties or get offered it. Guys who hear about a friend’s marital or girlfriend problems will half-joke that maybe the friend needs some Viagra to ‘spice things up a bit.’ Viagra has left the realm of a medically prescribed drug.”

The Daily Mail reports that Viagra “addiction” was implicated in the recent suicide of James Andrew, a 24-year-old writer. He committed suicide after his girlfriend stumbled on evidence that he’d been secretly using the drug. His body was found on a railway line on Valentine’s Day and investigation revealed that he had quarreled with his girlfriend, an Olympic ballet dancer, Eleanor Sharpe, after she questioned him over use of Viagra.

According to the Daily Mail. most young men try Viagra for the first time for recreational use or out of curiosity and not because they have any trouble achieving and sustaining a viable erection for sex. But most first time users of Viagra are deeply impressed by the relative stability of drug-induced erection and the extra stamina it imparts. Since men generally take pride in their sexual performance, young men, especially, who are very eager to impress their partners are susceptible to developing a pattern of psychological dependence on Viagra after first time use.

Viagra, “the little blue pill”

The Daily Mail. reports the case of Daniel, an entertainment promoter who was just 20 when he first used the pill. He had never suffered erectile problem, but he was deeply impressed by the extra stamina it imparted and soon developed a dependence. He stockpiled the drug spending about ВЈ1,000 a year in spite of warnings from his doctor about the long term effects that include heart problems and hearing loss. He would restock on the drug during visits to Spain. He explained: “The doctors there will prescribe them to you on the spot. Then you go to the chemist and get a supply. There’s always English people queuing who are after the same thing.”

Now, Daniel is worried about his established reliance on the drug. He takes about six tablets a week. He says: “if I know I’m due to see a woman, I discreetly take two pills beforehand. I know it’s bad for my health. I can hear my heart palpitating when I take the tablets, and I come out in cold sweats. Sometimes the beating is so loud, I think I am going to have a heart attack. I need some help to stop.”

The Daily Mail reports that a Harley Street psychosexual counselor, Raymond Francis, says he sees about 15 men with an average age of about 32 a month who are dependent on Viagra for sexual performance. He says: “I think this is just a small sample of the problem. These men don’t have any physical problems that would cause erectile difficulties. Instead they feel they need it because they are putting too many expectations on themselves.” He says some of his male patients are influenced by the Internet pornography. Men who are exposed to Internet pornography early in life acquire a dependence on pornographic images for sexual stimulation, experts say.

One of the more tragic consequences of a young man developing a dependence on Viagra is that it interferes with normal relationship because of the secrecy in which use of the drug is shrouded. It is easier to use Viagra secretly in circumstances of casual sex, but in stable and committed relationships, it is difficult to keep use of the drug secret. The anxiety arising from the fear of discovery complicates the picture and may interfere with the development of a normal intimate and committed relationship.

Sex experts also say that another factor in the growing use of Viagra among younger men is that 21st century ladies are more sexually confident, assertive and demanding. Since most men, especially young inexperienced men, depend on the relative inexperience and submissiveness of their partners for sexual confidence, they may feel intimidated by a self-confident and demanding young woman. Related to this are the exaggerated notions of male stamina required to satisfy a demanding female partner.

Most ladies are unaware of the extreme susceptibility of men to erectile problems under circumstances in which they perceive high expectations of performance by their partners. A sense of power and control in a sexual situation boosts a man’s sexual virility. Unrealistically high demands of sexual performance from a female partner exposes the male to performance anxiety and erectile dysfunction.

The Daily Mail reports that a young man lamented: “Women are now so empowered. They feel they have as much right as men to dictate the pace sexually. Before, it was always the expectation that the man was the predator. Now ladette culture has turned that on its head. Faced with this pressure, young men bring performance fears to the bedroom long before any sex takes place.”

A young woman Nicola, admitted that it was partly her sexual demands that triggered performance anxieties in her partner leading to erectile problems. She said: “When the sex wasn’t great, I was honest about how frustrated I was from the outset, which made the problem worse.” She added: “Women our age probably do have more of a sexual past. I’ve had 15 partners, while my partner’s only had five. “

Daniel says he is speaking up about his dependence on Viagra in spite of the secrecy and shame usually associated with use of the drug because he believes it is time for the growing problem to be openly discussed. He said “I am not ashamed of my dependence — I know so many guys my age with the same issues who started off using it recreationally.”

Erectile Dysfunction Health Center

This content has not been reviewed within the past year and may not represent WebMD’s most up-to-date information.

To find the most current information, please enter your topic of interest into our search box.

“>WebMD News Archive

Aug. 5, 2004 — Erectile dysfunction apparently isn’t just an older man’s problem anymore. Young men, even some who are college-aged, are leading the surge in Viagra use.

New research indicates that the use of Viagra skyrocketed 312% among men aged 18-45 between 1998 and 2002. There’s also been a twofold increase — 216% — among men between ages 45 and 55, says Tom Delate, PhD, whose research analyzed data on medical insurance claims by some 5 million patients across the country.

“We tried to see if these patients had an underlying medical condition and we couldn’t identify one in the majority,” says Delate, director of research for Express Scripts, Inc. a St. Louis-based firm that conducts pharmaceutical research for insurers, managed care organizations, and other companies.

“What we found was that problems typically seem to start in a man’s 40s and affected only about 40% of the men in these age groups.”

Enhancer Rather Than Remedy?

Does this suggest a growing trend in using the drug for recreational rather than medical purposes — such as for a sex enhancer?

“That would be my guess,” Delate tells WebMD.

While Delate notes that men older than age 56 continue to fill the lion’s share of prescriptions for Viagra, his study — published in the August issue of the International Journal of Impotence – also shows a 13% increase in Viagra prescriptions for women between ages 18 and 45. While some studies indicate that Viagra can increase sex drive and satisfaction levels in women, especially before menopause. this is not a consistent finding.

Delate also finds that two in three prescriptions came from primary care physicians, rather than urologists.

“One suggestion about what may be going on: It could be that patients are coming in, asking for the drug, and the prescriber wants to please the patients and meet their expectations,” he tells WebMD. “It could be the primary care physician doesn’t have a lot of time to spend with them, and may not be asking questions.”

Better Performance, Even if Not Needed

Viagra was the first oral drug approved for erectile dysfunction. which transiently affects nearly all men at some point, but occurs on a continued basis in as many as 20 million Americans. Erectile dysfunction can occur at any age, but typically affects men after age 50. Since Viagra, two other erectile dysfunction medications — Levitra and Cialis — have been approved by the FDA.

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